If you hurt a joint or strain a muscle, sometimes there’s comfort in knowing that at least others feel your pain. If you’re dealing with back pain, many will know exactly what you’re going through. The National Institute of Arthritis and Musculoskeletal and Skin Diseases reports that “back pain is one of the most common medical problems in the U.S. It can range from a dull, constant ache to a sudden, sharp pain that makes it hard to move.”
Back pain can be sorted into two big categories: acute pain and chronic pain. Acute pain comes on suddenly after a fall or after lifting something heavy and lasts no longer than six weeks. Chronic pain often develops slowly and lasts longer than three months, the NIAMSD reports.
Both acute and chronic back pain can arise from a variety of conditions. Therefore, depending on the cause of your back pain, you might end up seeing any one of a variety of specialists. Dr. Ronald A. Lehman, Jr., chief of degenerative, minimally invasive and robotic spine surgery at New York-Presbyterian’s Spine Hospital, says “primary care physicians, physiatrists, pain management specialists, sports medicine doctors and spine surgeons (orthopedic spine surgeons and neurosurgeons)” can all treat problems of the spine and neck. Other doctors, such as rheumatologists, may also be able to help with chronic back pain related to specific conditions such as arthritis or osteoporosis.
Lehman says some of the most common complaints patients seeking care describe include “low back pain, leg pain, leg numbness or the typical sciatica-type pain.” Sciatica is caused by compression of the sciatic nerve, which runs from the lower back into the leg, leading to pain radiating down one or both legs from the lower back. Other conditions that can cause back pain include nerve impingement (pinched nerves), slipped or herniated discs, spinal stenosis (pressure on the spinal cord and nerves) and arthritis.
Dr. Tom Reynolds, a physical medicine and rehabilitation specialist who focuses on spine patients at The Ohio State University Wexner Medical Center, says the predominant back pain issues he sees in his role as an intake physician are related to chronic conditions – sciatica, arthritis and nerve impingement. “I see people initially coming in and try to figure out where they fit best.” Patients with fractures or major spinal cord damage from accidents would likely go through the emergency department and find their way quickly to a specialized spinal surgeon. But for chronic conditions or less severe injuries, Reynolds says patients are typically referred to a back or spine specialist by their primary care physician or internist.
Patients seeking specialized care for back pain are usually offered nonoperative interventions first, Lehman says. “Many studies have shown that a course of physical therapy, nonsteroidal anti-inflammatory medications and sometimes injections will alleviate low back pain. If a patient has numbness, weakness, tingling or pain in the leg that does not improve with three to six months of conservative care, then some patients require operative intervention to decompress the nerves to alleviate the pressure.”
For patients who don’t need surgery, Reynolds says there are lots of options for restoring mobility while reducing pain. “If they don’t need surgery they usually wind up with one of us in rehab to try to figure that out. We’ll follow people along and see them every 6 months to make sure they’re doing their exercise programs, working on their posture and continuing with weight loss.” He says weight loss and exercise are often large components of rehabbing a painful back, because reducing the weight you’re carrying around can alleviate pressure on delicate joints and nerves along the spine and exercise can strengthen stabilizing muscles that can also divert pressure from sensitive areas.
Painkillers may also be part of the equation, but Reynolds says medication shouldn’t be the only approach your doctor uses. “You can manage the pain a little bit, but you have to find out what’s causing it and take care of that root problem.” You might be able to mask the pain with pain killers, but getting the issue to resolve fully is probably going to take some effort. Avoiding pain killers as much as possible may be a prudent move, especially given the ongoing opioid crisis.
Surgery may be an option for some patients if physical therapy and other nonsurgical measures don’t work, but this is typically an option only to be pursued for severe cases or after other interventions fail. When it comes to selecting a surgeon, Lehman says it’s imperative that “the patient and family should be comfortable that the surgeon has their best interests in mind, has proper training and gives them a transparent discussion about the risks and benefits of each intervention or surgery prior to their planned procedure.”
For patients with chronic back pain issues that don’t require surgery, it’s also important to find a doctor you click with. Reynolds says sometimes you’ll be under that doctor’s care longer-term, so developing a good working relationship with whichever doctor you’re seeing for back pain can help improve your outcomes. Asking friends and family for recommendations may be a good place to start and Reynolds suggests asking your primary care doctor who he or she would visit for this same problem or where he or she would send a family member for help.
When you do visit with a back or spine specialist for the first time, Reynolds says it’s very helpful if you can bring previous test reports with you. “If you’ve had any X-rays, an MRI, an EMG [electromyography, which measures muscle response to nerve stimulation] or CT scan studies, bring those reports and also bring the CD images of those studies. Those will allow the surgeon or us to see what has happened before you got here.” He says a timeline of when symptoms began and which specific treatments you’ve already had, such as a cortisone shot to reduce inflammation, and when those treatments occurred is critical information that the doctor can use to determine the best course of action. All this information can help the doctor avoid ordering additional tests that may not be necessary and may help pinpoint the problem faster, speeding up appropriate care.
Lastly, Reynolds says you should also “bring a list of questions. Think ahead a little bit and what’s important and what you want to know.” And ask away. “The worst question is the one you go home with unasked,” he says.